OP0155 CLINICAL IMPACT OF CARDIOVASCULAR MONOSODIUM URATE DEPOSITS MEASURED BY DUAL ENERGY COMPUTED TOMOGRAPHY: A RETROSPECTIVE EVALUATION
Authors: J. Held, C. Schwabl, G. Feuchtner, C. Duftner, G. Weiss, A. Klauser
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Gout is the most common inflammatory arthritis and doubles the risk of cardiovascular (CV) events.[1] Classical risk calculators like the Framingham risk score fail to sufficiently explain this higher hazard. [2] Recently, MSU deposits were demonstrated in coronary arteries of 86.4% of investigated gout patients and were positively associated with coronary calcium score. [3] So far, however, the significance of these findings on CV events and consequent impact for gout patients is unknown. <h3>Objectives</h3> The aim of this retrospective analysis was to evaluate 1) possible correlations of CV MSU deposits with clinical gout diagnosis 2) the impact of CV MSU deposits on major CV events (MACE) in gout patients. <h3>Methods</h3> All patients, recruited at the radiology department of medical university Innsbruck with clinically suspicion of gout, performed dual energy computed tomography (DECT) of the affected limb and thorax between 01.05.2012 and 01.09.2019. Clinical and laboratory parameters were retrieved from patients´ charts. Classical CV risk factors (diabetes mellitus, smoking status, hypercholesterolemia, arterial hypertension) were evaluated. Medical history review identified the presence of MACE, defined as myocardial infarction and/or stroke. Patients were stratified in gout, hyperuricemia and controls. Gout was defined according to the ACR/EULAR classification criteria [4], uric acid levels over 6 mg/dl or ongoing uric acid lowering treatment without clinical signs of gout specified hyperuricemia patients and control group definition was achieved when uric acid levels were normal without concomitant uric acid lowering therapy and absence of gout symptoms. We performed the χ2- and Mann-Whitney tests for statistical appraisal of our dataset, using IBM SPSS (version 27). <i>P</i> &lt;.05 was used as the cut-off for statistical significance. <h3>Results</h3> Overall, full data sets were available for 189 patients. Out of those, 131 (69.3%) revealed a clinical diagnosis of gout, 50 (38.2%) of these were tophaceous. 35 patients (17.5%) had hyperuricemia and 23 (12,2%) had neither gout nor elevated uric acid levels. Patients with CV MSU deposits (n=85/189, 45%, 62 gout patients, 19 hyperuricemia patients, 4 control patients) revealed higher acute phase reactants [C-reactive protein (p=0,001), erythrocyte sedimentation rate (p=0,007)], uric acid levels (p=0,007) and calcium scores (p&lt;0,001) in comparison to patients without CV MSU deposits. MACE were observed in 35 patients (18.5%) with a higher prevalence in those patients revealing CV MSU deposits (n=22/85, 25,9%) compared to those without CV MSU (n=13/104, 12,5%) (p=0,022). All 22 patients with MACE and CV MSU were gout or hyperuricemia patients (Figure 1). <h3>Conclusion</h3> To our knowledge, this is the first evaluation of clinical features of patients revealing CV MSU deposits detected by DECT. The higher prevalence of MACE in patients with CV MSU deposits may help for risk stratification of gout patients, as classical CV risk scores or laboratory markers fail to identify patients at risk. <h3>References</h3> [1] Cox, P., et al., <i>The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis.</i> Rheumatol Int, 2021. <b>41</b>(7): p. 1209-1219. [2] Krishnan, E., et al., <i>Gout and the risk of acute myocardial infarction.</i> Arthritis Rheum, 2006. <b>54</b>(8): p. 2688-96. [3] Klauser, A.S., et al., <i>Dual-Energy Computed Tomography Detection of Cardiovascular Monosodium Urate Deposits in Patients With Gout.</i> JAMA Cardiol, 2019. [4] Neogi, T., et al., <i>2015 Gout Classification Criteria: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative.</i> Arthritis &amp; Rheumatology, 2015. <b>67</b>(10): p. 2557-2568. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.